| NPI | 1982164273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME161565) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD61643625) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-07-07 |